Claude-Alix Jacob, MPH, Chief Public Health Officer for the Cambridge Public Health Department (MA), has served as NACCHO’s President since last July. Jacob is a long-standing and dedicated member of NACCHO and has served on a variety of different advisory groups including the Annual Conference Workgroup, the Health Equity and Social Justice Committee, the Survive and Thrive Workgroup, and the Finance Committee. He has served on NACCHO’s Board of Directors since 2010. He recently spoke to NACCHO Voice about his experience as president, the challenges facing local health departments, and what he is looking forward to doing after his term is over.
What has surprised you most about your tenure as President? What have you learned?
CJ: Truly, it’s been an honor to represent the organization as the chair of the board over the course of the past year. Despite having served on the board for a number of years, I now have a much better appreciation for the staff and work of the association, especially at this time of major transitions. Two surprises and lessons to note from my tenure this year. First of all, the year goes by fairly quickly. It seems that just as I am getting acclimated to the pulse of the board and the routine of staff, the term is coming to an end. During this year, we experienced a change in leadership at NACCHO and established an interim co-lead team to guide the organization while we conduct a national search for a permanent executive director, whom we plan to have in place by next spring.
In addition, we have been paying closer attention to the nuances of the new presidential administration and the impact of proposed legislative changes on the work of our membership. As you can imagine, there is looming concern that an erosion of funding support for the governmental public health enterprise may have drastic effects on the local level. Whether we’re talking about the capacity to respond to local emergencies, the access and utilization of health and social services, the trauma related to substance misuse, or other emerging public health issues, any changes in the status quo tend to generate some level of angst in local communities.
These scenarios drive home for me the value of the NACCHO brand. Our mission is to be the leader, partner, catalyst, and voice with local health departments. One of our greatest assets is our ability to adjust to adversity on the ground. I feel strongly that we have become even more novel in our work and that we serve as an amplifier for our national membership. That’s something that I’ve come to appreciate now in my tenth year as an active member of NACCHO and completing my seventh year on the board.
What have you most enjoyed about serving as President? What are you most proud of?
CJ: I’ve most enjoyed my interactions with NACCHO staff and fellow board members, encounters with our membership, and the support our national partners from coast to coast. I have come to enjoy the invitations to tell our story—not only about what’s happening in Cambridge, MA, but also with the pulse and perspective of our national association. About a month ago, I was in an executive committee meeting with our state affiliate and, unbeknownst to me, one of our members around the table had attended the Preparedness Summit and happened to see me provide remarks as part of the opening plenary session. After my report to the executive committee, he told me how proud he was to know there was someone representing the Commonwealth of Massachusetts at a national conference. These types of interactions with students, other members, community partners, and funders are the encounters that I’ve really enjoyed over the course of the past year.
In terms of what I am most proud of, it’s important for me to acknowledge the contributions of the board of directors as ambassadors of the association and the support made available to the NACCHO staff and national partners. This year, the board has focused its energies on strengthening its processes through the work of our various committees, which this year included the work of the nominations committee, bylaws committee, and audit committee. In addition, we established an ad hoc governance task force to take a hard look at the mechanics of the board, including reviewing the onboarding experience for new members, developing NACCHO’s strategic plan, and revisiting the board’s metrics. It has done my heart good to see the board take on these assignments not only on behalf of the governing body but for the good of the association. At the same time, I’m proud of the role that the board can play in how we’re helping to guide the NACCHO enterprise through these various transitions that included moving to a new office space and initiating a national search for a permanent executive director.
In the end, I take great pride in the fact that we have strategic partners who help to tell our story and demonstrate the value of what we do as an association. Whether it’s the Association of State and Territorial Health Officials, the American Public Health Association, the Council of State and Territorial Epidemiologists, or Trust for America’s Health, to name a few—it’s been great to demonstrate value to our partners and the funders who support our work.
What has changed for local health departments and/or the field of public health in the past year?
CJ: Quite a bit has changed and continues to change. One major issue that we are grappling with is the future of the Affordable Care Act (ACA). The ACA provides significant funding to health departments through the Prevention and Public Health Fund, as well as increased access to health insurance coverage and preventive services. Dismantling the ACA could change the core functions of local public health—our regulatory work, our work with our partners in public safety, our capacity to prevent and control the transmission of communicable diseases, our chronic disease prevention efforts, and our capacity to address emerging threats like the ongoing burden of overdoses in our communities.
Both the American Health Care Act, passed by the House of Representatives in May, and the Senate’s Better Care Reconciliation Act, the fate of which remains uncertain, would eliminate essential resources to governmental public health at the federal, state, and local levels. The Senate’s bill would phase out Medicaid expansion established by the ACA, which provides critical access to care for millions of Americans. Additionally, the legislation would eliminate funding for the Prevention and Public Health Fund in FY2018, which makes up 12% of the Centers for Disease Control and Prevention’s budget. Eliminating the fund would put at risk programs vitally important to local health departments. NACCHO and its members have been advocating tirelessly to educate Members of Congress about how cutting the Prevention and Public Health Fund and scaling back Medicaid would harm local health departments and the health of the communities they serve.
Additionally, the workforce is contracting. Although we did see an improvement in the number of local health department employees hired in 2015, on the aggregate, we have lost substantial capacity over the course of the last eight or nine years. That is a major change and continues to be a major concern when one considers the wave of potential retirees expected in the near future. On the flip side, we are encouraged to see the number of health departments that are committing to the voluntary accreditation process for local health departments, mostly through the completion of community health assessments and community health improvement plans in collaboration with local stakeholders.
What challenges are on the horizon and how can NACCHO help LHDs tackle them?
CJ: NACCHO can magnify our reach by making sure that our community partners understand the importance of paying attention to these drivers or determinants of health. We depend on cross-system collaborations, especially now. In many communities, local health departments are recognized as the health strategists of record on the ground. NACCHO must continue to amplify that vision and that message. We have policy statements that speak to local health departments’ role as the Chief Community Health Strategists, which is a great start. We also recently launched a Public Health 3.0 resource center, which contains resources and information related to each of the five recommendations spelled out in Public Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure, the report from the U.S. Department of Health and Human Services. Our spring issue of NACCHO Exchange, our quarterly magazine-journal, is all about how local health departments are implementing the community health strategist framework on the ground. This is yet another opportunity to align NACCHO’s vision with its mission, which is to serve as a leader, partner, catalyst, and voice with local health departments.
What are you looking forward to doing once your tenure concludes and you have more free time?
CJ: I feel like I’m graduating from the NACCHO “board bootcamp” in one sense. I have been humbled by the phenomenal trail blazed by my predecessors who served as the national chair of the board for our esteemed association. I now have a much better appreciation for the breadth and complexity of NACCHO as an organization.
As an elected officer on the board, I will remain on the executive committee for one more year in the role of the Immediate Past President. In this role, I am charged with chairing the Nominations Committee and I’ll focus on ensuring that we continue to recruit strong talent to the board. Also, I will serve as the board’s liaison to the Council of Past Presidents, which is made up of a cadre of illustrious members who date back a few decades.
To that end, I would like to congratulate Dr. Umair Shah as NACCHO’s incoming President along with the newest “recruits” to the board. I look forward to working with the board during the 2017–18 term, which will include completing NACCHO’s strategic plan as well as recruiting a permanent executive director. In addition, I would like to thank the members of the board and our national partners for their tireless service and support during the 2016–17 term. Lastly, I would like to express my sincere thanks and appreciation to Dr. William Barnes and Laura Hanen for accepting the call to serve as the NACCHO’s Interim Executive Directors during this transitional year.
Back in Cambridge, we’ve been undertaking an effort to become one of the first accredited health departments in the Commonwealth of Massachusetts and I’ll now have a chance to turn my focus and energy to ensuring that we complete the next phase of the documentation process. We’re also in the midst of restructuring as a department and revisiting a myriad of organizational functions—it’s a heavy lift and I’ll be able to ensure that we execute this next chapter successfully. I should add that my experience as the board chair was made possible, in large part, due to the tremendous support of the leadership at the Cambridge Health Alliance and the City of Cambridge as well as the incredible talent at the Cambridge Public Health Department.
On a personal note, this season has been a time of self-reflection about my priorities, not only as they pertain to NACCHO but also to my own growth and professional development. During this year, I tried to spend quality time at home and attempted to make every one of my kids’ soccer games. One decision I made through this experience on the board was to pursue my doctoral degree in public health. As a result, I will be initiating this next journey at the end of the summer although some may call me a glutton for punishment! I figured that since I have this momentum and the “NACCHO wind” at my back, I may as well push forward full-throttle and apply these invaluable lessons learned. In the end, I have made NACCHO my professional association and truly believe there is no time like the present. Carpe Diem.